Provider Demographics
NPI:1184928202
Name:VILLAFANE, ALLYSON RAE (MA)
Entity type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:RAE
Last Name:VILLAFANE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 LAKESHORE DRIVE
Mailing Address - Street 2:APT 311
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403
Mailing Address - Country:US
Mailing Address - Phone:631-655-5362
Mailing Address - Fax:
Practice Address - Street 1:903 LAKESHORE DR
Practice Address - Street 2:APT 311
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2826
Practice Address - Country:US
Practice Address - Phone:631-655-5362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8250Medicaid
FL8250Medicare UPIN
FL8250Medicare PIN